Hospital's policy on mentally ill criticized

Patients need to stay longer, critics believe

The psychiatric unit operated by Ventura County Medical Center keeps patients for an average of four days, too little to keep them from coming right back, critics say.

“This system is broken,” said Duane Bentzen, a Calabasas man whose son has schizophrenia.

Bentzen says his son was released after four days in the unit called Hillmont Psychiatric Center with no real improvement in his condition. The 27-year-old Ventura man ended up on the streets afterward, sleeping for two nights in the city’s Cemetery Park before calling for help, Bentzen said.

It’s an issue that relatives of seriously mentally ill children have been raising off and on for years. But now the county’s Mental Health Board is examining the matter in depth in an attempt to cut recidivism rates that board members say cost not only the mentally ill and their families but also the taxpayers.

About 15 percent of patients admitted to the unit return within 30 days, say county managers of the unit.

Managers are surveying other counties to see if that compares well with their facilities, but the rate of rehospitalization is expected to be in line with similar institutions. They also say the length of stay makes sense given Hillmont’s mission of stabilizing people in crisis.

“Once that emergency abates, they are supposed to go to a lower level of care,” said Dr. John Fankhauser, medical director of Ventura County Medical Center. “That can normally be done within three days.”

Jean Farley, chief deputy public defender overseeing mental health cases, said that standard seems to have been relaxed lately. Once the emergency 72-hour hold for an evaluation of the patient expires, the county can hold patients for up to two more weeks if doctors determine they are a danger to themselves or others, or gravely disabled.

Some patients oppose the two-week hold in required hearings before a judge, but in the past three weeks, there have been no cases at all, Farley said.

The attorney said she has been unable to reach anyone at Hillmont for an explanation but that her case files suggest something has changed.

“It’s pretty easy for somebody like me to figure out because I’ve been doing this for 30 years,” she said. “If there’s documentation in the file that the person is threatening to slit their wrists, they’ve tried it before, they’re in the hospital for 48 hours and they’re not certified (to be held) any longer, there’s something wrong. It’s happening in 99 percent of the cases.”

Curtis Ohashi, the chief operating officer who oversees Hillmont, said he had no knowledge of the situation. Both he and VCMC administrator Paul Lorenz said there has been no change in the way doctors recommend discharging patients.

In March, state evaluators determined doctors were not justifying the reasons for admitting patients to the psychiatric unit in sufficient detail to qualify for state payments, based on a sample of charts they reviewed.

Since then, physicians have been educated on how to meet the state’s requirements, Fankhauser said.

Ronald Thurston, a psychiatrist who sits on the Mental Health Board, said the panel of relatives, clients and professionals is examining Hillmont’s results as part of an effort to develop a continuum of care.

The real problem is there’s no place for the patients to go when they leave, he said.

“They’re not acute, but that doesn’t mean they’re fine to go home,” he said. “They need some supportive care in a step-down facility.”

Hillmont operates in isolation without adequate connections to other levels of care, he said.

Ventura County has the money to open a residential center where patients could get additional treatment for up to 30 days, but officials have not yet secured a site.

County health officials say doctors still make decisions about whether patients will stay or go, based on medical and legal reasons. Officials said they are not being pressured by state cutbacks to change those decisions.

“People would not be released because of billing issues,” said Meloney Roy, director of the county Behavioral Health Department. “The client need has to come first. When you’re dealing with people who are suicidal or a danger to themselves or others, I can’t imagine anyone releasing someone because they don’t think there’s not going to be reimbursement for their care. It’s antithetical to everything the agency stands for.”